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          <h1 class="post-title" itemprop="name headline">牙医折寿？</h1>
        

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        <p>之所以会产生这个问题，是因为前两天在某公众号上看到一篇2019华南展卡瓦公司iCare”青年牙医计划”论坛的报道。正好华南展我也去了，但是没有去听这个论坛，于是读了一下。很多嘉宾的观点我深受启发，要是我刚入行的时候能有这样的指导，会少走很多弯路啊。但是有位嘉宾有一个说法：“台湾牙医平均寿命58岁，在日本他们的统计牙医的平均寿命低于国民平均寿命将近20岁，世界的高危职业之一就是牙医……”。说实话这惊到我了，当牙医这么折寿，我要不要考虑改行？嘿嘿，我就查一下，找到两篇文献，正好一篇是日本的，一篇是台湾的。</p>
<p>Shimpo H , Yokoyama E , Tsurumaki K . Causes of death and life expectancies among dentists[J]. International Dental Journal, 2011, 48(6):563-570.<br>这篇没找到全文，只有摘要。<br>通过牙医死亡报告计算东京牙医的标准死亡率，以便于普通东京市民的死亡率相比较。进一步的，编制寿命简表(abridged life table)，计算这些牙医的预期寿命。在1985-1994年间一共记录了560位男性牙医的死亡记录。用普通东京市民作为参考人群，牙医的食管癌和结肠癌的标准化死亡率显著的高于普通市民，心脏病和肺炎/支气管炎的死亡率显著低于普通市民。25岁的东京牙医的预期寿命是51.26岁。其出生时的预期寿命是75.37岁，比普通市民稍低（76.67岁），但差异没有统计学意义。<br>Shang T F , Chen P C , Wang J D . Mortality among dentists in Taiwan, 1985-2009.[J]. Journal of the Formosan Medical Association, 2012, 111(10):567-571.<br>这篇有全文。<br>研究目的：牙医职业暴露是否影响其寿命。<br>方法：使用寿命表分析系统，计算了11700位台湾牙医协会会员的标准化死亡率。追踪时间从1985年-2009年。资料按照死因，性别，年龄分组，并与台湾普通人群，还有18664位内科医生的数据进行对比，后者被认为社会经济条件与牙医类似。并使用Cox proportional hazard模型进行分析。<br>结果：与台湾普通人群相比，台湾牙医的所有死因的死亡率均降低。然而，与内科医生相比，牙医的一些指标显著的升高，总死亡率(SMR = 1.13, 95%可信区间[CI] = 1.00-1.26），溺亡(drowning)(SMR = 6.62; 95%CI = 2.15-15.45), 心脏病(SMR = 1.66, 95% CI = 1.22 - 2.21)。在调整了其它危险因素后，牙医的相对危险率为1.77(95%CI = 1.01 - 1.37）。<br>牙医潜在暴露于有害化学物质，物理和生物因子之中，如银汞合金，麻醉剂，噪音，震动，放射线，以及病毒等。尤其显著的，牙医暴露于乙肝病毒和艾滋病病毒之中。进一步的，牙医面临很大的压力，有很高的自杀率，至少在医疗专业人员当中。<br>也有报道牙医更容易患脑癌，肺癌，以及生殖系统肿瘤。<br>直到2009年12月31日，一共有11700位牙医，207831.11人-年的累计追踪，在这期间，有289位牙医死亡。2/3的牙医在1995年以前开始执业，超过90%的牙医开始执业的年龄小于30岁。牙医的几乎所有死因的标准化死亡率均低于台湾普通人群的一半。内科医生的自然死亡率(crude death rate)要高于牙医(6.4% vs 2.5%)，但调整了年龄，性别和开始执业的年龄以后，这种差异就没了。（意思是内科医师开始执业的年龄要大于牙科医生，因此死亡率要高一些。）<br>详细数据看下表<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0108-yyzs/01.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0108-yyzs/02.png"><br>这是首次“全国”范围内的长期的牙医死亡率的追踪研究。牙医的死亡率要低于普通民众，这也许部分的要归功于健康提供者效应(HWE）现象，但只与普通人群对比是不合适的，因为二者的社会经济状况差别很大。因此本研究用内科医生来与牙科医生进行对比。</p>
<p>最后是我看了文献的结论啦。第一，牙医的预期寿命并不比普通民众低（台湾），或者虽然低，但差异并不显著（日本东京）。所谓“在日本他们的统计牙医的平均寿命低于国民平均寿命将近20岁”，应该是指的25岁的时候的预期寿命，也就是在25岁的时候平均还能活51.26岁，总寿命是76.26岁。第二，从台湾的结果来看，虽然牙医并不比普通民众折寿，但是牙医与内科医生相比死亡率还是高一些，主要是心脏病，溺亡，自杀（但自杀率并不高，7/289)。<br>所以，当牙医还是很安全的，不过同行们还是要注意自我保护哦。</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“好看”。谢谢。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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